Debt Review Form Debts Repayments Details Web Site 1. Tick the Debtors that apply to you: checkbox ANZ Aust Premier CBA Cash Converters Cashtrain Cigno Credit Corp Inhouse Finance Jacaranda Money3 Moneyme Moneyspot Moula NAB Nimble Quickcash Rapid Loans Shield St George Sunshine Swoosh Telstra UME Loan Wallet Wiz Westpac Others (Not Listed) 2. Fill Out Your Corresponding Debt: Total Amount You Owe Total:$ Estimated Amount you Pay Back with Solve My Debt Now Total:$ Estimated Savings you Make Total:$ *These results are the average we have achieved for your debt type and are indicative only. Payback Period 1Year 2 Years 3 Years Weekly Payment Amount Total: $ Amount you pay to us (including our fees) to pay your debts for you and negotiate debt reductions 3. Your Details: Email Address * First Name * Last Name * Mobile * Terms Agreed I have read and accept the Terms and Conditions and I agree to be bound by them. User Acknowledgment I acknowledge that the payment plan options accepted by me today are based solely on the debt amount information I have provided to Solve My Debt Now on this form. I further acknowledge that should my actual debt amount be higher or lower than the amount I have listed today, my regular payment plan option that I signed up today for will become higher or lower to reflect that.